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HomeMy WebLinkAboutBLUSKY RESTORATION CONTRACTORS LLC - INSURANCE CERTIFICATEACORO® �- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/30/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AOn Risk Insurance Services West, Inc. Denver CO Office CONTACT NAME: A/C. N . EXt): (303) 758-7688 FAX No ): (303) 758-9458 E-MAIL ADDRESS: 1900 16th Street, suite 1000 Denver CO 80202 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: The North River Insurance Company 21105 BluSkV Restoration Contractors. LLC 9767 E Easter Ave. Centennial CO 80112 USA INSURER8: Liberty Mutual Fire Ins Co 23035 INSURER C: Lloyds Syndicate No. 1458 AA1120102 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570076097576 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested ILTR TYPE OF INSURANCE A I SD WVD POLICY NUMBER MM/DD/YYYY MM DD/YYYY LIMITS C X COMMERCIAL GENERAL LIABILITY ENVP 1Z7771=EACH OCCURRENCE $1,000,000 CLAIMS -MADE —1 OCCUR DAMAGETO RENTED PREMISES Ea occurrence $100,000 MED EXP (Any one person) $ 5 , 000 PERSONAL B ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY ❑X PRO ❑ LOC JECT PRODUCTS - COMP/OPAGG $2,000,000 OTHER. A AUTOMOBILE LIABILITY 133-745562-9 05/01/2019 05/01/2020 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident C X UMBRELLA LIAB X OCCUR ENVX000020019 05/01/2019 05/01/2020 EACH OCCURRENCE $10,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE $10 , 000 , 000 DED RETENTION B WORKERS ORKE SCORS'MPENSABILATIONAND YIN ANY PROPRIETOR / PARTNER/ EXECUTIVE WC2Z91462479019 05/01/2019 05/01/2020 OTH X SPER TATUTE IER E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ❑ NIA A E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E1. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) BluSky Restoration Contractors, Inc. certifies that liability insurance in the amount of $1,000,000 that indemnifies the City against any and all loses that may arise from the use of the parking spaces per contract stipulations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE r� EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ft. Collins AUTHORIZED REPRESENTATIVE J 215 N. Mason street Ft. Collins Co 80537 USA �/f �i �i ,,Q n t asik�Jn.�V�tancz eJrtvizD X r Jura ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000079106 LOC #: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Insurance Services West, Inc. B1u5ky Restoration Contractors, LLC POLICY NUMBER See Certificate Number: 570076097576 CARRIER NAIC CODE See Certificate Number: 570076097576 EFFECTIVE DATE. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. iNSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE :NM/DD/YY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS EXCESS LIABILITY C ENVP000024819 05/01/2019 05/01/2020 Aggregate $5,000,000 Each Occurrence $5,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD